Peristomal Moisture–Associated Skin Damage in Adults With Fecal Ostomies

Abstract

Approximately 1 million persons living in North America have an ostomy, and approximately 70% will experience stomal or peristomal complications. The most prevalent of these complications is peristomal skin damage, and the most common form of peristomal skin damage occurs when the skin is exposed to effluent from the ostomy, resulting in inflammation and erosion of the skin. Despite its prevalence, research-based evidence related to the assessment, prevention, and management of peristomal moisture-associated skin damage is sparse, and current practice is largely based on expert opinion. In order to address current gaps in clinical evidence and knowledge of this condition, a group of WOC and enterostomal therapy nurses with expertise in ostomy care was convened in 2012. This article summarizes results from the panel's literature review and summarizes consensus-based statements outlining best practices for the assessment, prevention, and management of peristomal moisture-associated dermatitis among patients with fecal ostomies.

An electronic approach to minimising moisture-associated skin damage in ostomy patients

“…Inflammation and erosion of the skin surrounding the stoma site is remarkably common and can arise through a number of factors but, in the overwhelming majority of cases, it can be attributed to prolonged exposure to urine or stool [1][2][3][4][5]. The collection of effluent from the stoma is almost invariably achieved through the use of a pouch system, which is attached to the abdomen through an adhesive skin wafer (flange or faceplate) placed over the stoma [7,9].…”

“…The degree and rate of exposure will depend on a number of factors related to the stoma output (principally frequency, volume and composition). The presence of skin creases and the mechanical flexing of the wafer as a consequence of activity can greatly exacerbate the failure of the seal and allow ingress of moisture leading to irritation which, if left untreated, can rapidly develop into a PSC [1][2][3][4][5].…”

“…An estimated one million patients, in the US alone, live with the routine of ostomy care and it is likely that a significant number will have experienced some form of peristomal skin complication (PSC) [1]. Statistics on the prevalence of the complaint are highly variable (ranging from 10% to 70%) [1][2][3][4][5] and reflect issues in the reporting procedures adopted by different healthcare systems [4,6].…”

“…A step change is needed in the technological approaches to ostomy management and it is our hypothesis that an opportunity for such change could be emerging. It is our assertion that the impetus may come, not from any renewed interest from the medical funders but, rather startlingly, as a consequence of investigations into energy harvesting -a field with undoubted global importance, but one which is wholly unrelated to the more immediate concerns of ostomy patients suffering with PSCs.Inflammation and erosion of the skin surrounding the stoma site is remarkably common and can arise through a number of factors but, in the overwhelming majority of cases, it can be attributed to prolonged exposure to urine or stool [1][2][3][4][5]. The collection of effluent from the stoma is almost invariably achieved through the use of a pouch system, which is attached to the abdomen through an adhesive skin wafer (flange or faceplate) placed over the stoma [7,9].…”

“…The degree and rate of exposure will depend on a number of factors related to the stoma output (principally frequency, volume and composition). The presence of skin creases and the mechanical flexing of the wafer as a consequence of activity can greatly exacerbate the failure of the seal and allow ingress of moisture leading to irritation which, if left untreated, can rapidly develop into a PSC [1][2][3][4][5].Inadequate seals at the skin-wafer interface are often attributed as a primary cause of peristomal moisture-associated skin damage (MASD) and there are many studies which confirm that those in the immediate post-operative period are most at risk [3,4]. It is http://dx.…”